BULLETIN FOR PROFESSIONALS May 2019

WHAT’S INSIDE Chronic Child Neglect What is chronic neglect?

Chronic child neglect occurs when a caregiver Implications for child repeatedly fails to meet a child’s basic physical, welfare developmental, and/or emotional needs over time, Casework practice to establishing a pattern of harmful conditions address chronic neglect that can have long-term negative consequences for health and well-being. This differs from a Multisystem report of child neglect, which refers to a single collaboration and incident of failing to meet a child’s basic physical, partnerships psychological, or safety needs. While Federal Evidence-informed statistics indicate that approximately three- interventions quarters of all child maltreatment victims in the United States during fiscal year 2017 were victims State and local of neglect (U.S. Department of Health and Human examples Services, 2019), chronic child neglect is more Competencies and difficult to quantify. Child welfare systems often training lack the assessment tools, time, and resources to analyze child protective service reports and Importance of hope records for patterns that may constitute chronic child neglect. Conclusion

References

Children’s Bureau/ACYF/ACF/HHS 800.394.3366 | Email: [email protected] | https://www.childwelfare.gov Chronic Child Neglect https://www.childwelfare.gov

This bulletin outlines how child welfare professionals can When these three identifiers result in cumulative harm identify and understand chronic neglect and looks at the or serious risk of harm to the child’s safety, health, important role of casework and community partnerships or well-being, a child can be said to be chronically in strengthening families and their ability to provide neglected. Using this framework, chronic child neglect safe care for children. It explores prevention and early can be defined as a parent or caregiver’s ongoing, intervention efforts to prevent and moderate the harmful serious pattern of deprivation of a child’s basic physical, effects of chronic neglect; outlines information on training developmental, and/or emotional needs for healthy and evidence-informed interventions; and provides growth and development (Kaplan, Schene, DePanfilis, & State and local examples of ongoing work to address Gilmore, 2009). chronic neglect through casework practice, community States hold varying definitions of child neglect. Only collaboration, and efforts to build family well-being and two States, Oklahoma and Washington, refer specifically resilience. to chronic child neglect while others allude to it in their What Is Chronic Neglect? definitions (e.g., Kentucky, Pennsylvania, and North Carolina). Chronic child neglect refers to cases in which families are reported to child protective services (CPS) for multiple For more information, see Child Welfare Information incidents of neglect in multiple domains rather than single Gateway’s State Statute publication Definitions of Child instances of a specific type of neglect. It may accompany Abuse and Neglect (https://www.childwelfare.gov/topics/ other forms of maltreatment and often coexists with systemwide/laws-policies/statutes/define/). enduring poverty, co-occurring mental health issues, Child Welfare Information Gateway’s Acts of Omission: substance use disorders, and domestic violence. Child An Overview of Child Neglect (https://www.childwelfare. welfare systems may consider neglect to be chronic gov/pubs/focus/acts/) addresses incident-based neglect, based on its duration, frequency (e.g., the number of whereas this bulletin considers the accumulated record of CPS reports or substantiated reports), a family’s ongoing neglect over time. For information on intergenerational need for services, or referrals for multiple types of neglect, see Intergenerational Patterns of Child maltreatment. Maltreatment: What the Evidence Shows (https://www. There are several widely accepted indicators of chronic childwelfare.gov/pubs/issue-briefs/intergenerational/). child neglect: Risk Factors ƒ One or more needs basic to a child’s healthy Similar to incidents surrounding many types of child development are not met. neglect—physical, educational, emotional, medical, etc.— ƒ The neglect happens on a recurring or enduring basis. chronic child neglect occurs within a social context that ƒ The neglect is perpetrated by a parent or a caregiver. may include risk factors related to the family, community, and society. Prevention and remediation of chronic neglect requires reducing the associated risk factors and strengthening the protective factors that promote child safety and well-being.

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A study of the case records of 38 families with five or more Using Data to Identify Risks screened-in reports of neglect in a large Northeastern jurisdiction demonstrated multiple stressors associated The Community Opportunity Map (https:// with chronic child neglect: financial stressors in 92 percent www.casey.org/community-opportunity- of the families, substance use in 85 percent, domestic map/) is a free tool created by Casey Family violence in 79 percent, and parental mental health issues Programs to help identify at-risk neighborhoods in 76 percent (Semanchin Jones & Logan-Greene, 2016). and families by increasing access to publicly The study also showed that most families (89 percent) available community data in zip codes across included a child experiencing significant emotional or the United States. The tool highlights ecological behavioral issues. A majority were single-parent families. indicators associated with child maltreatment The most frequent allegations in initial reports were, as well as factors associated with strong families in descending order, inadequate guardianship; lack and safe children from the city level down to of supervision; parental substance use; minor physical individual neighborhoods. Local governments, abuse (bruises, scrapes, welts, etc.); and inadequate food, policymakers, child welfare leaders, and clothing, or shelter. community service providers can use it to determine which neighborhoods and families are Vulnerable families may not understand that their having the hardest time keeping children safe and children may be at risk. Because chronic neglect is often a how to work with those families to help improve recurring problem for such families, child welfare agencies outcomes. are at risk of underserving them (Inkelas & Halfon, 1997) or having low expectations that parents can change (Daro, 1988). Caseworkers who embrace a strengths-based approach and who maintain optimism and a forward- While assessing for chronic neglect requires the thinking attitude are more likely to inspire change in the consideration of a family’s full pattern and comprehensive families they serve. history of child neglect, rather than determining whether a specific alleged incident did or did not occur, most Protective factors in families and communities can child protection statutes, policies, and protocols assess help mitigate the risk factors associated with chronic for specific incidents (American Humane Association, neglect. This includes building a family’s resilience, 2010). Several risk factors that may be predictive of social connections, knowledge of parenting skills and chronic neglect include the following (Logan-Greene & child development, concrete supports, and the social- Semanchin Jones, 2018): emotional competence of children. For more information, see Child Welfare Information Gateway’s Prevention ƒ Families with children under age 1 and/or larger Resource Guide (https://www.childwelfare.gov/topics/ families preventing/preventionmonth/resources/resource- ƒ Families with multiple allegations at the time of report guide/) and Protective Factors Approaches in Child ƒ Substantiated allegations in the first report to CPS Welfare (https://www.childwelfare.gov/pubs/issue-briefs/ ƒ Families with a child/children who was/were in the care protective-factors/). or custody of others in the past ƒ A parent or caregiver with a history of domestic violence, substance use, mental health issues, social isolation, and/or cognitive impairment

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Impacts of Chronic Neglect children and families experiencing chronic neglect. The Children who have experienced chronic neglect may Building Capacity to Address Chronic Neglect From suffer serious cognitive and social deficits because of the a Systems Perspective learning experience includes a potential lack of responsive parent-to-child interaction simulated task force of child welfare administrators and that is essential for healthy child development (Logan- frontline caseworkers who address chronic neglect- Greene & Semanchin Jones, 2018; O’Hara, et al., 2015; related concerns flagged in the most recent Federal Child Painter & Scannapieco, 2013). Chronic child neglect and Family Services Reviews. Learning modules include can also result in abnormal physical development, a the following: compromised immune system, and long-term chronic ƒ Understanding chronic neglect physical disease. The impacts of chronic neglect on ƒ Locating and using data sources to evaluate the need children can be cumulative and like those from trauma for change exposure (e.g., difficulties with emotion regulation). ƒ Strategies for evaluating and implementing adaptive Children who have experienced chronic neglect may and technical challenges to change develop insecure or disorganized attachment issues, social withdrawal, learning deficits, poor school ƒ Leveraging community relationships and services performance, internalization of negative behaviors, and Users can create a free online account to access learning changes in the brain due to toxic stress. Chronic neglect modules that explore the processes and partnerships also has been linked to aggression and delinquency needed to respond to chronic neglect (https://learn. in adolescence, particularly in boys (Logan-Greene & childwelfare.gov/). Topics include strategies for building Semanchin Jones, 2015). The societal impact of chronic support for change, understanding the role of agency neglect may include school absenteeism and dropouts, culture in responding to chronic neglect, and the substance use, crime, and high costs to child welfare importance of collaboration. systems, juvenile courts, and schools (Capacity Building Center [CBC] for States, 2018). Integrating Approaches Along the Child Welfare Continuum For more information on the impact of neglect on child Community-based child abuse prevention and differential development, see The Science of Neglect: The Persistent response are two approaches that can be used to address Absence of Responsive Care Disrupts the Developing chronic neglect. Community-based prevention and early Brain from the Center on the Developing Child at intervention services (e.g., family support, home visiting, Harvard University (https://developingchild.harvard.edu/ etc.) can help keep families from becoming chronically resources/the-science-of-neglect-the-persistent-absence- involved with child welfare. The FRIENDS National Center of-responsive-care-disrupts-the-developing-brain/). for Community-Based Child Abuse Prevention (FRIENDS) Implications for Child Welfare has a toolkit on preventing child neglect (https:// friendsnrc.org/neglect-toolkit) and offers the Protective It is essential for child welfare leaders to take a Factors Survey (PFS) (https://www.friendsnrc.org/ comprehensive and holistic approach to responding to protective-factors-survey)—as well as the second edition families experiencing chronic neglect in the communities (PFS-2) of the survey—for use with parents and caregivers they serve. This section explores some of the strategies to participating in family support and child maltreatment address the complex nature of chronic child neglect. prevention services. The PFS and PFS-2 identify multiple The Children’s Bureau’s CBC for States developed a protective factors that can help prevent child abuse and professional development tool that provides detailed neglect. Both surveys can help agencies and programs guidance on how to affect systems change to benefit assess changes in family protective factors—a major focus of prevention work.

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In differential response, public child welfare systems Casework Skills assign screened-in CPS reports either to an investigative It is imperative for caseworkers to demonstrate the track or to an assessment track. For families served following skills and strategies when working with families through the assessment track, caseworkers conduct a dealing with chronic neglect (Kaplan, Schene, DePanfilis, comprehensive assessment with an emphasis on child & Gilmore, 2009): safety concerns and service needs, all while suspending ƒƒ Ability to engage families and their support systems the need to substantiate the child maltreatment holistically allegation. For families who are chronically coming to the attention of child welfare, it is believed that the ƒƒ Well-honed risk assessment and decision-making skills, assessment track provides greater access to services including a recognition of patterns of neglect designed to prevent the recurrence of child maltreatment. ƒƒ An understanding of the role of hope and how to By encouraging a broader and more thorough assessment inspire it in struggling families of a family’s potential safety and risk issues, differential ƒƒ Ability to help families sustain positive changes before response has the potential to flag safety concerns for closing a case caseworkers and to be useful in cases of chronic neglect (Johnson, 2009). Differential response emphasizes Intake meeting a family’s broader needs through direct and Caseworkers can look for common indicators of chronicity community-based services and has been shown to when screening reports of neglect, such as the number reduce the need for traditional public child welfare of reports during a specific timeframe and the range services while enhancing family engagement, access to of allegations of neglect across multiple domains (e.g., and participation in services, and satisfaction with the hygiene, supervision, etc.). Caseworkers should consider caseworker (Loman & Siegel, 2015; Ruppel, Huang, & a family’s entire history and take note when numerous Haulenbeek, 2011). The importance of providing families risk factors exist in the midst of few, if any, protective with early intervention services before a pattern of chronic factors. Tapping into partnerships with other social neglect develops cannot be overemphasized. service providers, educators, and local law enforcement may help to fill in details about a family’s history. This For more information on differential response, see initial discernment can inform next steps, as caseworkers Differential Response to Reports of Child Abuse consider the impact of the cumulative risk of harm from and Neglect at https://www.childwelfare.gov/pubs/ chronic neglect. issue-briefs/differential-response/. Successful Engagement Casework Practice to Address Chronic Neglect Engaging with a family can increase a caseworker’s ability to gauge the level of neglect, determine the family’s Persistent and pervasive chronic child neglect in a specific needs, and influence factors affecting safety. The community can overwhelm local child protective systems quality of this relationship can be a powerful factor in and drain resources required to investigate or assess CPS change. Caseworkers can do the following to engage the reports (Loman, 2006). Because chronic child neglect is family: often entrenched in the family dynamic, confronting it ƒƒ Listen to and address issues that concern the family requires a positive attitude, resolve, resources, skill, and while identifying and attending to their immediate patience. This section looks at steps caseworkers can take needs to work with families impacted by chronic neglect. ƒƒ Identify family strengths and networks of support within the community to address the identified concerns

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ƒƒ Focus initially on “baby steps” (small actions that lead that periodically create safety threats (DePanfilis, 2006). It is to immediate improvements in the parent’s life and the important to understand the parents’ perspective on what child’s life) and avoid overwhelming the family with too their challenges are as well as what they believe would many services at once increase their capacity to meet their children’s needs. ƒƒ Focus on improving the capacity of family members to meet their basic needs and improve child and family safety and well-being A study of families experiencing chronic neglect ƒƒ Recognize and praise parents’ strengths, especially in the Northeast found that commonly used risk examples of sensitivity to and concern for children in assessment tools may not be good at predicting the family chronic neglect, perhaps because they look at ƒƒ Return to the home regularly to develop a relationship a point in time rather than the accumulation of with the caregiver and to evaluate the family’s progress harm that comes from chronic neglect (Logan- over time Greene & Semanchin Jones, 2018). In addition to conducting a comprehensive assessment of family Casework interventions should seek to empower strengths and needs, the authors identify the caregivers by providing them with choices whenever following as key to responding to chronic neglect possible and engaging them in the decision-making (Semanchin Jones & Logan-Greene, 2016): process. A search should be conducted for extended family members who might be helpful to children and ƒƒ More consistent use of standardized risk and parents for respite care or, if needed, for out-of-home safety assessment protocols care (Wilson, 2016). Family members and extended kin ƒƒ Better recognition of past patterns of neglect can also provide valuable moral support, emergency ƒƒ Effective supervision for coaching, support, assistance, and help to develop parental resilience (i.e., and accountability for frontline staff the ability to rebound from adversity). ƒƒ Manageable caseloads For more information, see Family Engagement: Partnering ƒƒ Use of specialized chronic neglect teams With Families to Improve Child Welfare Outcomes at https://www.childwelfare.gov/pubs/f-fam-engagement/. Assessment Comprehensive and individualized assessments can help Case Planning and Intervention to identify family members’ unique strengths and needs Partnering with families to help them identify their as well as the associated safety threats and risk factors strengths and needs allows them to feel greater for chronic neglect (Johnson, 2009). Instead of focusing ownership of their case plan and more invested in the on incident-based neglect, assessments should identify outcomes. The following are elements to consider when referral patterns, parental strengths and challenges, and intervening on behalf of families dealing with chronic possible sources of ongoing support. To make such a neglect (Corwin, Maher, Rothe, Skrypek, & Kaplan, 2014): determination, the initial assessment should consider two ƒ Meeting the concrete needs of the family first points: (1) family history and cumulative developmental ƒ Building trust with the family members by keeping and physical harm resulting from neglect and other types promises and promoting regular contact and of maltreatment and (2) services that have been utilized accessibility in past interventions. The assessment should carefully evaluate whether children’s basic needs are met and ƒ Developing the family’s skills through small and whether there is evidence of recurring omissions in care measurable steps with clearly defined goals

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ƒ Strengthening the family’s support network Visit Child Welfare Information Gateway’s webpage ƒ Working with the family beyond 12 months on Cross-System Collaboration in Prevention Services (https://www.childwelfare.gov/topics/preventing/ ƒ Using casework teams and promoting self-care to developing/collaboration/cross-system-collaboration- avoid caseworker burnout and secondary trauma in-prevention-services/) and the FRIENDS webpage (see Information Gateway’s webpage at https://www. on Promising/Emerging Multi-System Efforts (https:// childwelfare.gov/topics/management/workforce/ friendsnrc.org/neglect-toolkit/policies-public-systems/ retention/turnover/burnout/) promising-emerging-multi-system-efforts) for additional Case Closure examples of multisystem collaboration. Families need a plan should they find themselves slipping Evidence-Informed Interventions back into the circumstances that brought them to the attention of child welfare agencies or if new issues arise. Several evidence-based interventions and promising At the very least, such a transition plan will provide family programs may prevent and mitigate conditions related members with the means to access ongoing family and to chronic child neglect. Because of the socioecological community supports as well as any needed services. context in which chronic child neglect occurs, Caseworkers should ensure there is an appropriate interventions require actions that go beyond standard handoff to community service providers in the event service provision (Corwin, et al., 2014). This section looks families require ongoing assistance and provide the at a sampling of interventions that may be relevant to families with information on how to seek services after chronic neglect cases. their case is closed. The California Evidence-Based Clearinghouse for Child Multisystem Collaboration and Welfare (CEBC) features a registry of evidence-based and nonevidence-based child welfare-related practices and Partnerships interventions. Of the more than 300 programs it lists for Community and multisystem partnerships can help children and families, only 5 programs specifically address to create a holistic response to chronic neglect and a neglect (CEBC, 2018). For more information, see the CEBC multidisciplinary approach to engaging and supporting website at http://www.cebc4cw.org/registry/. more families. Potential community partners may include private child welfare agencies, courts, substance use While the five CEBC programs do not address chronic and mental health treatment providers, housing systems, child neglect specifically, interventions and programs that early childhood centers, schools, and faith communities. may be useful for families experiencing chronic neglect Data from child welfare agencies, school counselors, include the following: community centers, and families receiving Temporary ƒ Child First (http://www.childfirst.org/) is an intensive Assistance for Needy Families, housing, food bank, or therapeutic home visiting model for primary caregivers Medicaid help may help identify populations needing and their children from birth through age 5 who help (CBC for States, 2018). Collaboration should be are at high risk for developmental, emotional, or tailored to the characteristics and strengths of the behavioral problems or maltreatment. Child First community (FRIENDS & National Alliance of Children’s (Family Interagency, Resource, Support, and Training) Trust and Prevention Funds, 2018). connects families with community-based services to reduce family stress levels and provides in-home FRIENDS developed a collaboration toolkit to promote clinical services to help build parent-child attachment, effective community collaboration efforts. The toolkit heal trauma in both the caregiver and child, and includes information on collaborating with the substance prevent additional toxic stress. use, mental health, and domestic violence systems (https://friendsnrc.org/neglect-toolkit).

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Child FIRST is rated as a “near top-tier” program by ƒ SafeCare (http://www.safecare.org) is an evidence- the evidence-based policy team at Social Programs based home visiting program for parents and That Work (formerly the Coalition for Evidence-Based caregivers of children ages 0 to 5. With over 60 studies Policy). Families participating in a Child FIRST trial conducted to validate the program, SafeCare has were found to be 39 percent less likely to be involved a CEBC rating of 2. The program focuses on three with CPS and had a 98 percent increase in access risk factors that are key for chronic neglect cases: to community services and supports (Robert Wood the parent-child relationship, child health, and home Johnson Foundation, 2015). safety. The Washington State Institute for Public Policy ƒ Childhaven Childhood Trauma Treatment (http:// (WSIPP) rated SafeCare as having the highest financial www.childhaven.org) is an evidence-based therapeutic return on every dollar invested—$22.41—in a cost- child care program with a CEBC rating of 2—or one benefit analysis of various child welfare programs that is supported by research, according to CEBC’s (WSIPP, 2018). Scientific Rating Scale—for infants and children aged State and Local Examples 1 month through 5 years and their families. Intensive early intervention and specialized treatment services Several initiatives are underway aimed at reducing risk are provided in a licensed child care setting to heal factors for chronic neglect and addressing its harmful the effects of early toxic stress, prepare the child for effects on children and families. learning, and improve parenting skills to strengthen Colorado family relationships and build family resilience. The Colorado Community Response (CCR) voluntary ƒ Family Connections (http://www.family.umaryland. program provides families who have been reported edu/fc-replication) is a comprehensive family-centered to CPS—but whose cases were screened out—with home and community-based program for families comprehensive services, including access to vital support with children ages 0 to 17 designed to help caregivers services, case management, and resource referrals to meet the basic needs of their children and reduce the increase their ability to meet their children’s needs. risk of neglect. Family Connections seeks to increase An evaluation of CCR found that families participating family protective factors and decrease the risk factors in the program enhanced protective factors, built associated with child maltreatment. CEBC rates the social capital, increased stability, improved family program a 3, or one backed by promising research functioning and self-reliance, and received concrete evidence. Family Connections is governed by several supports (Colorado Department of Human Services, service principles that may be particularly useful in Office of Early Childhood, 2018). Additionally, families practice with families experiencing chronic neglect. who completed CCR had lower rates of repeated child This includes community outreach, individualized welfare involvement than those who did not complete the family assessments, tailored interventions, and program. outcome-driven service plans. ƒ Homebuilders (http://www.institutefamily.org/) is an Connecticut evidence-based program for parents and caregivers of Connecticut’s Office of Early Childhood (OEC) developed children ages 0 to 17 with a CEBC rating of 2 that offers several innovative programs with potential to help families intensive family preservation services to help keep that may be dealing with chronic neglect (A. McKenna, families together. The program is designed to engage personal communication, August 28, 2018). families by serving them in their home environment and may be useful in neglect cases by helping primary OEC launched a results-oriented initiative that caregivers improve their supervision of children and incentivizes home visit providers to achieve important access to community-based supports. goals for children and families, such as a reduction in

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child maltreatment and increased parental employment District of Columbia (https://www.ct.gov/oec/lib/oec/ct_oec_miechv_rate_ The District of Columbia Child and Family Services card_fact_sheet.pdf). The OEC pilot program uses an Agency (CFSA) has instituted an “In-Home Levels-of- outcomes rate card to reward providers with a bonus Care” system to help caseworkers address safety and risk payment for every family that achieves the following: factors that may perpetuate chronic neglect. The CFSA ƒ A healthy birth that avoids a risky and costly preterm levels-of-care system ensures that families with multiple delivery and complex needs receive more intensive engagement ƒ Avoidance of emergency room visits or substantiated and attention. Each level of care defines a graduated claims of child maltreatment that result in high costs set of family needs, interventions, contact requirements, and future treatment needs and case-length standards (R. Matthews and L. Walker, ƒ Attainment of measurable stability goals by at-risk personal communication, August 8, 2018): families, including secured child care, health care, and ƒ Intensive-level cases are those where a substantial housing risk to the safety and well-being of children has been ƒ Caregiver employment or completion of a job-training flagged through the CPS investigation or a family is program or educational attainment that will help already being served through an in-home case. The advance family economic stability majority of intensive-level cases have an active safety plan. Cases may be assigned to the intensive level The pilot is built on a public-private partnership between when a court petition has been filed to spur compliance OEC and the Hartford Foundation for Public Giving, which with a case plan (referred to as community papering is contributing outcomes payments for providers in the and is particularly relevant to cases of educational or Hartford area. nonemergency medical neglect, substance use, or OEC’s Mind Over Mood (MoM) maternal mental mental health problems). Other examples that might health initiative helps young mothers with postpartum fall under the intensive-level category include cases depression and the related mood disorders that can where children are perceived to be vulnerable due to contribute to maternal neglect. The MoM initiative gives special needs or age, or where there is a perceived risk expectant and new mothers access to insurance-covered of exposure to domestic violence. clinical services through a central phone line and in-home Intensive cases remain open for 8 to 10 months, and services. MoM has processed over 250 referrals for clinical a CFSA social worker will meet face to face with the services that help to create maternal, infant, and family family once a week at a minimum. Families with an well-being in multiple areas, including the following (A. active safety plan may require more contact. The McKenna, personal communication, August 28, 2018): social worker ensures a team meeting is held within ƒ Decreased anxiety and depression symptoms 60 days of the completion of the initial case plan, and ƒ Increased bonding with baby and enjoyment of additional meetings are held as needed. caregiving ƒ Intermediate-level cases are those with multiple ƒ Increased parental sensitivity risk factors (e.g., homelessness, limited life skills and support networks, difficulty meeting children’s needs) ƒ Increased ability for self-care that are deemed to require considerable attention and ƒ Improved self-esteem oversight to ensure children’s needs are being met ƒ Increased motivation and planning for the future but where there is no imminent risk or danger. In these ƒ Enhanced ability to meet daily demands cases, which remain open for 6 months, a social worker visits twice a month at a minimum to ensure the family is moving toward case plan goals.

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ƒ Graduation-level cases are those where the family level of care, CFSA reviews it to determine whether a has demonstrated that there is no imminent risk or different level of care should be assigned or whether a danger and child welfare involvement is no longer new direction is needed (e.g., community papering or necessary. Cases remain open for 30 to 60 days at out-of-home care) (R. Matthews and L. Walker, personal the graduation level, with the social worker making at communication, August 8, 2018). least one visit to the home to discuss case plan goals Wisconsin and progress, barriers, and safety. At the close of the case, a celebration is held to reward progress and to Wisconsin’s Community Response Program (CRP) was develop a sustainability plan for the family. The family created as a prevention program model for families is provided with a list of contacts that they can go who are screened out of CPS or whose cases are to for help and a signed certificate that shows they unsubstantiated but who demonstrate characteristics have completed services. CFSA social workers make associated with chronic neglect and are deemed at high a referral to the family’s neighborhood collaborative risk for a future CPS referral. CRP provides its families with to ensure the family has a smooth transition into a case management, home visits, collaborative goal setting, continuum of care. Typically, a CFSA social worker a comprehensive assessment, and access to financial contacts the collaborative for an internal meeting to supports for up to 20 weeks. One of its primary goals is update them on the case, followed by a joint home visit to reduce the economic stressors that can be associated with the family. CFSA has moved away from the use of with child maltreatment. CRP staff meet with families the term “voluntary” services to encourage families to to identify immediate needs and to connect them with see child welfare as a continuum. If a family declines both formal and informal resources to meet those needs. services, family members are assured that they are CRP seeks to strengthen the families it serves, prevent always welcome to seek help from the collaborative at maltreatment, and reduce repeated referrals to CPS. any time. For more information, see https://preventionboard.wi.gov/ CFSA’s restructured in-home case management Pages/OurWork/CommunityResponse.aspx. system seeks to ensure that social workers are better at Oregon assessing a family’s underlying needs, increasing teaming efforts with families and providers, and developing In Oregon, community-based crisis relief nurseries case plans to help families change their behaviors and provide infants and young children at risk of early increase protective factors to improve child safety. maltreatment with early learning and skills to help build In circumstances where, for example, children are resilience. The relief nurseries offer early intervention consistently missing school or when parents are not programs to help overcome potential developmental attending parenting classes, CFSA may seek court delays and early trauma; strengthen parenting and approval for community papering to spur a change in primary caregiver skills; and preserve families through the family’s behaviors. This has helped with parental home visits, support services, mental health counseling, participation and accountability and has increased court parenting classes, early childhood education, and more. involvement in cases that might not normally receive court Learn more on the Oregon Association of Relief Nurseries oversight. When a family successfully addresses its safety website (https://www.oregonreliefnurseries.org/). issues, CFSA may close the case. If unsuccessful, CFSA may move children to out-of-home care. When a case extends beyond the accepted period for the assigned

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Competencies and Training Importance of Hope Specialized training is key to providing professionals When families and caregivers have hope, they are more with a clear understanding of the complexities of chronic likely to work toward case goals and achieve safety, well- neglect. being, and permanency. It is essential for caseworkers to motivate families through an optimistic and strengths- Trainings should include the following: based approach so that they engage in services and ƒƒ How to engage with families, identify their informal work toward positive goals. Child welfare professionals supports, and relate to them as experts on their own can support families by helping cultivate positive strengths and needs relationships, experiences, and environments that work to ƒƒ How to listen effectively to support a family and tailor buffer ACEs and promote healthy childhood development services to their specific needs (Sege & Browne, 2017). For State and local examples of ƒƒ How to perform comprehensive assessments that how a public health approach to child welfare, reliance consider the family’s past patterns of neglect and on community data, and the science of ACEs and brain identify risk factors such as substance use, cognitive development are working to improve child and family impairment, or domestic violence safety and well-being, see the following reports: ƒƒ How to work with the Strengthening Families ƒ Balancing Adverse Childhood Experiences With HOPE Protective Factors framework to promote family well- (Health Outcomes of Positive Experiences): New being and prevent recurrences of neglect Insights Into the Role of Positive Experience on Child and Family Development (https://hria.org/resources/ ƒƒ Research on adverse childhood experiences (ACEs) hopereport/) to help adult family members understand their own trauma and how to minimize adversities for their ƒ The Evolution of Hope: How Communities Across children America Are Building Better Futures for Their Children and Families (https://www.casey.org/hope2017/) ƒƒ Research on early childhood science and brain development ƒ Moving Hope Forward: How Safety, Knowledge, and the Power of Community Can Transform Lives (https:// www.casey.org/hope2018/) Chronic neglect cases may affect agency Conclusion workload issues because of their complex Chronic neglect is the product of significant and multiple characteristics. For more information on stressors on individuals and families with the potential managing casework loads, see Information to span generations, particularly absent effective Gateway’s issue brief, Caseload and Workload interventions that consider these complex factors. Management, at https://www.childwelfare.gov/ Partnerships that share common goals and make good pubs/case-work-management/. use of community resources are essential in efforts to remediate and prevent chronic neglect. More research, prevention, and early interventions—combined with As mentioned on page 4, Building Capacity to Address concrete supports and hope-based initiatives—are Chronic Neglect From a Systems Perspective simulates a needed to address chronic neglect and its far-reaching child welfare task force to explain chronic child neglect effects on children and families. and how to address it. The comprehensive learning modules are available on the CBC for States website at https://learn.childwelfare.gov/.

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U.S. Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau